Logo image
Back
Anaphylactic Shock During Oculofacial Plastic Surgery in a Patient With Midazolam and Tetracaine Allergies
Journal article   Peer reviewed

Anaphylactic Shock During Oculofacial Plastic Surgery in a Patient With Midazolam and Tetracaine Allergies

Rupin N. Parikh, Dustin Lode, Brian K. Gehlbach, Amy M. Yoder Dowden and Erin M Shriver
Ophthalmic plastic and reconstructive surgery
04/08/2026
DOI: 10.1097/IOP.0000000000003216
PMID: 41949442

View Online

Abstract

Anaphylactic shock is a rare but life-threatening perioperative emergency characterized by bronchospasm, hypoxia, and hypotension. A 56-year-old woman underwent elective oculofacial plastic surgery and developed anaphylactic shock shortly after exposure to tetracaine eye drops; intravenous sedation with midazolam and propofol; and a local anesthetic mixture of lidocaine, bupivacaine, and epinephrine. Initial signs included facial flushing, hypotension, and oxygen desaturation. Intubation, epinephrine, steroid, and intensive care unit transfer were required. Blood tryptase drawn 2.5 hours after the onset of symptoms was within normal range, but subsequent allergy testing revealed positive reactions to both midazolam and tetracaine. The patient fully recovered and was discharged the following day. She underwent successful surgery 6 months later under general anesthesia. This case underscores the importance of early recognition of anaphylactic shock and the necessity of procedure rooms being well equipped to intervene. Vigilance is necessary even with agents not commonly associated with anaphylactic shock.

Details

Metrics

1 Record Views
Logo image